About the service:

Gokul-Vrandavan is residential care home that was providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service provides care to Gujarati elders and all staff speak to people in their chosen language. The service observes Gujarati culture.

People’s experience of using this service:

¿People told us they received good care. We were told ‘’it’s a happy house’.

¿Staff had the skills and knowledge to deliver care and support people in a person-centred way.

¿Staff recruitment was safe and staff understood how to keep people free from harm.

¿Relevant risk assessments had been completed to ensure people were kept safe.

¿Medicines were managed safely.

¿Accidents and incidents were monitored to identify and address any patterns or trends to reduce risks.

¿People were supported with good nutrition and could access appropriate healthcare services.

¿People were encouraged to see their families as they wanted.

¿People were treated with respect and dignity and their independence was promoted. We received positive feedback about the kindness of staff.

¿People took part in activities and events both within the service and the local community, based on their interests and preferences.

The service met the characteristics of Good in all areas; more information is in the full report

Rating at last inspection:

At the last inspection the service was rated Good (9 June 2016).

Why we inspected:

This was a scheduled inspection based on the rating of the last inspection.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 9 June 2016 and was unannounced.

Gokul Nivas is a care home that provides residential care for up to 10 people and specialises in caring for Gujarati Asian Elders whose first language is Gujarati. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were six people in residence.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had appointed a care manager. They were supported by the deputy manager to manage the service on a day to day basis in the absence of the registered manager who was managing services outside of this area. The care manager was supported by registered manager from the service next door, which is a service for the same provider.

People told us they felt safe at the service. People using the service were protected from abuse because the provider had taken steps to minimise the risk of abuse. Staff understood their responsibility in protecting people from the risk of harm.

Staff were recruited in accordance with the provider’s recruitment procedures. There were sufficient numbers of staff to meet people’s needs and to promote their safety and wellbeing. Staff were supported through training, supervisions and had regular meetings which helped to ensure staff had the knowledge and skills to support people and an opportunity for personal development.

People’s care needs were assessed including risks to their health and safety. Care plans were updated and centred on people’s needs, which included the measures to help promote their safety and independence. Care plans provided staff with clear guidance about people’s needs which were monitored and reviewed regularly.

People lived in an environment that was homely and comfortable. We found equipment such as the profile bed and the shower room were not well maintained. Action was taken by the care manager when we brought it to their attention to ensure the equipment and premises were safe and fit for use. However, the provider should take steps to routinely monitor the service and equipment used in the delivery of care remain safe and in good condition. There were ongoing improvements and refurbishment being made to the service and the care home next door which is within the same provider group. There was a secure garden which people could use safely.

People received their medicines at the right time. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health. People were provided with a choice of meals that met their health and cultural dietary needs.

People’s consent had been appropriately obtained and recorded. The management team and staff team understood the principles of the Mental Capacity Act and how they might apply to the people who used the service. When staff had concerns about people’s capacity then they sought advice and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

People were involved and made decisions about their care and support needs. Information was provided in a form that the person could understand and enabled them to make choices about how they wish to spend their day. People were supported to observe their faith and take part in activities, which met their cultural needs and interests and also new activities being introduced to people who previously may not have had the opportunity.

We saw staff showed care and kindness towards people using the service. People told us staff were caring that they had confidence in them to provide the support they needed. The

This inspection took place on 12 October 2015 and was unannounced.

Gokul Nivas is a care home that provides residential care for up to 10 people and specialises in caring for Gujarati Asian Elders whose first language is Gujarati. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were seven people in residence and one person was in hospital.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

As part of this inspection we looked at the improvements made by the provider and to confirm that they now met the legal requirements.

People told us they felt safe at the service and with the staff that looked after them. Staff understood the safeguarding procedure (protecting people from abuse) and knew how to keep people safe.

People’s care needs were assessed including risks to their health and safety when they started to use the service. However, improvements were needed in relation to how risks to people’s health and wellbeing were assessed, monitored and reviewed. Care plans were not reflective of people’s current needs, which meant people may receive unsafe or inappropriate care.

The systems to store, manage and administer medicines safely were not followed correctly. Further action was needed to ensure the national guidance was followed in relation to safer management and administration of people’s medicines.

Staff were recruited in accordance with the provider’s recruitment procedures. Further action was needed to ensure there were sufficient numbers of staff available to meet people’s needs safely and reliably.

Staff received an induction when they commenced work and on-going training to support people safely. We saw staff used equipment to support people correctly. Staff received support through meetings and staff appraisals. Staff would benefit from training and support to understand the needs of people living with dementia and how to support them practically so that their wellbeing is promoted.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been followed. Further action was needed to ensure a mental capacity assessment was carried out to so that people’s wishes were known and kept under review. Where a person lacked capacity to make decisions or were unable to do so, the provider had not acted in accordance with their legal responsibilities to ensure that any best interest decisions made involved the relevant people and health care professionals.

People were provided with a choice of meals that met their cultural and dietary needs. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance.

There were limited planned activities which people could take part in. People were supported to observe their faith.

People did not consistently receive care that was person centred and the care plans did not reflect their wishes and preferences. Staff had some knowledge of people’s life history and what was of interest to them despite the lack of information in the care records. Further action was needed to ensure people were at the centre of their care; ensure staff were available and systems were in place to ensure people experienced tailored care and support as outlined in the provider’s aims of the service provided.

People were confident to raise any issues, concerns or to make complaints. However, we found that concerns raised were not always addressed. Although there were regular meetings held for people who used the service, the issues raised were not always addressed.

The provider’s quality governance and assurance systems were fragmented. There were limited audits carried out and those too were ineffective. There was no evidence to demonstrate that the provider reviewed, identified shortfalls and took steps to make improvements.

There was a registered manager in post. However, they were not in day to day charge of the service because they were managing services outside of this area. We found the service was managed by the registered manager and supported by staff from the service next door, which is a service for the same provider.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014. 

The inspection was unannounced which meant the manager and staff did not know we were coming.

Gokul Nivas provides accommodation, care and support for 10 people whose first language is Gujarati.  There was a registered manager in post at the home. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager for Gokul Nivas did not work in the home and spent limited time there. The day to day running of the home was the responsibility of the care manager.

Providers are required by law to inform the CQC of incidents in the home that could affect the health, safety and welfare of the people who use the service however despite identifying incidents which met this criterion during our inspection, we could not be confident that these had been reported, as required.

The Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) were not being respected by staff which meant people’s human rights had not been recognised.

The staff we spoke with, including the care manager had limited understanding of their role in protecting and respecting people’s rights and their own responsibility to work within the law.

Most of the people we spoke with said they were happy with the care they received but some people were reluctant to raise concerns about their care with the staff or manager.

We observed some positive interactions between staff and the people who used the service however we also saw some interactions which did not provide people with the support they required or maintain their dignity.

There were limited arrangements in place to measure the quality or effectiveness of the care that was provided.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We were unable to speak in depth with people using the service due to the language barrier. However, people we saw told us they were happy living at the home and said the food was lovely.

During our visit we observed staff interacting with people and found they were kind and respectful at all times. The staff were representative of the culture of people who used the service and were able to communicate with people in their own language. We found people’s religious needs had been considered and respected. The home provided vegetarian Indian meals and supported people to attend the temple. In addition people had access to Asian television channels and activities that included religious readings and singing.

Staff had a good understanding of the needs of people who used the service and demonstrated a good rapport with people. We found that people were confident approaching staff and that carers were responsive to people’s needs.

We saw that people had a choice about whether to spend their time in their room or in the communal areas. People were engaged in reading, singing or yoga in the main living room and staff participated in these activities.

We looked at the records of three people who used the service and found care plans were detailed and thorough and provided clear guidance to staff about how the persons’ care should be delivered.

Staff had been appropriately screened to ensure they were suitable to work with vulnerable people.

There were appropriate arrangements were in place for the obtaining, recording and administration of medicine.

Records were accurate and fit for purpose.

We spoke with a relative who was visiting the home at the time of our inspection. They told us their family member was always asked how she would like her care to be provided and that she was very happy at the home. They said: - “it’s very nice with proper food….they get her what she wants and I would recommend to anyone”. We asked the relative about whether staff were properly trained and able to meet his mother’s needs. They told us carers were: - “kind, friendly and knew what they were doing”. The relative also said that there was good communication between family and the home and he was always kept informed of his mother’s welfare.

We were unable to communicate with people using the service due to the language barrier. During our visit we observed staff interacting with people and found they were kind and respectful at all times. We observed that staff had a good rapport with people using the service.

We looked at the results of the latest questionnaires that had been given to people using the service, relatives and visiting professionals, e.g. district nurses. These asked a number of questions about the care being provided, staffing, the environment and if there were any concerns. The overall response was very positive.